One of the strange things about depression is that the return of joy may not come first.
It begins in the shower, without twenty minutes arguing with the self. The dishes get done. A phone call is answered rather than stared at. None of it seems miraculous, but somebody close you is likely to see the change before you.
Bupropion, an antidepressant known as Wellbutrin, can make those everyday things seem possible again.
It is not a fast boost to be used by anyone, and in fact the first week might feel as if you’ve been drinking coffee since Monday.
Why is Wellbutrin different?
Most famous antidepressants work primarily through serotonin, but bupropion mostly affects norepinephrine and dopamine.
This provides the drug with its own personality. It can feel more energizing, which can be precisely what somebody low in motivation and stuck in bed all day needs to hear.
For somebody already tense and unable to sleep, the same quality is a liability.
Bupropion treats major depression, and the extended-release version can also be used to prevent seasonal depression in those whose mood regularly dips during a specific time of year. This same drug is marketed as Zyban for smoking cessation.
Wellbutrin is also less likely than other SSRIs to interfere with sex, and may be trialled in cases where another antidepressant has lowered libido, caused a delay in orgasm or erection issues.
Less likely is not synonymous with impossible, however, and depression itself can dull sexual desire, so these issues are not always caused by the medication.
The beginning is not always a good sample
A person takes their first dose on Monday and feels edgy by Tuesday. They have trouble sleeping and find food less appealing, and by Thursday they are ready to give up.
It is often too soon.
Dry mouth, nausea, headaches, constipation and a generally unsettled, wired feeling can begin, and these are frequently eased as the body adjusts to the medicine. Taking it earlier in the day may help sleep, and temporarily cutting back on caffeine can make the jitteriness more tolerable.
Improvements in mood take longer. Some find that energy levels begin to rise within a week or two, while interest, pleasure and hope return more gradually. Four to six weeks is a far more realistic window of opportunity than four to six days, although the person who prescribed it may reassess earlier.
A sudden worsening of depression is not something to be quietly endured. Antidepressants carry a warning about suicidal thoughts and behaviors, particularly children, adolescents and young adults in the early weeks and after a change in dose.
New thoughts of self harm or frightening impulsiveness or a sudden drop in mood needs specialist help. If there is a possibility that someone may act on these thoughts, contact emergency services or a crisis service immediately.
The labels on the box make a difference
Bupropion comes in immediate release, sustained release and extended release versions. You may see IR, SR or XL written next to the name of the drug on the box.
They work at different speeds and are not interchangeable. A 150 mg SR tablet is not the same as a 150 mg XL tablet that can be taken at any time of day or as needed.
Modified release tablets should be swallowed whole. Breaking, chewing or crushing them increases the amount of bupropion taken at once, raising the risk of side effects and, more seriously, causing a seizure.
Wellbutrin SR is generally taken earlier in the day and with regular intervals between doses as per the prescription. Missed a dose and the next one is due soon? Simply skip it. Do not take a double dose if you have missed one.
Why are you asked about seizures, eating disorders and alcohol?
Bupropion can increase the risk of seizures. At standard doses the risk is low for most people, but certain factors influence the situation.
Wellbutrin is not prescribed to someone with a seizure disorder, and it is also avoided in those who have or have had anorexia or bulimia as these eating disorders increase the chances of a seizure.
Alcohol requires a frank discussion. Heavy drinking followed by sudden withdrawal can cause seizures and bupropion can contribute to this. Stopping a benzodiazepine or seizure medication abruptly has the same concern.
This is not to say that any Wellbutrin user suddenly decides to binge drink and then stop cold turkey. It means “How much do you drink?” has to be a genuine question. Do not suddenly stop heavy drinking without specialist help.
Make sure every prescriber knows about any other bupropion products you are taking. Taking Wellbutrin for depression and Zyban for smoking cessation would mean taking the same drug.
A few other modifications are worth watching out for
Appetite is often reduced and weight loss can be a side effect. This can become an issue when a change in diet and further loss of weight become impossible to manage. Wellbutrin is not a benign weight loss drug.
Blood pressure can be affected, particularly if the person is also using nicotine replacement therapy. It is a good idea to check it occasionally if you already have hypertension.
Then there are the changes that feel nothing like typical side effects: barely sleeping without tiredness, racing thoughts, reckless decisions, rapid speech or an overwhelming feeling of being unstoppable. These can be signs of mania, and occasionally bipolar disorder can be mistaken for depression.
Hallucinations, paranoia or severe confusion are also signs to get help straight away. A swollen face, difficulty breathing or a blistering rash is an emergency.
Bupropion can interact with other drugs and should not be taken near an MAOI antidepressant. Kidney or liver problems may require a different dose.
Feeling well again does not mean the end of the tablet
This one catches people out regularly.
Life improves and work becomes more manageable. Friends stop asking if you’re all right and the medication feels pointless, so the patient stops taking it.
Sometimes depression returns. Sometimes stopping the medication causes irritability, anxiety, difficulty sleeping or other unpleasant symptoms. Bupropion tends to cause fewer classic withdrawal problems than some serotonin based antidepressants, but a gradual reduction in dose is still preferable to a decision to stop on a Sunday morning.
Medication is only one part of the road to improvement. Talking treatments can help tease out how depression has affected relationships and self esteem. Sleep, food, exercise and human interaction are also vital – not because depression can be cured by going for a walk, but because recovery needs a place to start.
Our guide on whether antidepressants are worth considering can help with that choice.
Wellbutrin does not manufacture happiness. When it works, it gives some people enough energy and mental space to begin finding their own way towards it.
